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Functional outcome following Philos plating for displaced proximal humeral fractures

Abstract
Aim: To assess the functional outcome following internal fixation with the PHILOS plating system for displaced proximal humeral fractures by using the ASES and Constant scoring system. Background: Controversy exists with regards to the management of displaced proximal humeral fractures and many methods of treatment have been proposed over the years. In particular, the role of surgery has not been clearly defined. The current trend is toward limited dissection of the soft tissues with the use of minimal amounts of hardware to gain stability. Methods: We performed a retrospective analysis of 30 consecutive patients treated surgically with the PHILOS plate for a displaced proximal humeral fracture between February 2002 and October 2003. Patients were assessed clinically and radio graphically at an average follow-up tine of 9 months. Functional outcome was determined utilising the American Shoulder and Elbow Score (ASES) and Constant Murley score. The injury was classified using Neer 4 part classification. Results: Average age of the patients was 58 years (19 to 92). There were 6 two part, 14 three part and 10 four part fractures. All the fractures were radio graphically united by 10 weeks. The average overall ASES score is 66.5%. The average overall Constant score is 55%. The average external rotation at 90 of abduction for the ages 15-55 was 55?-64?and the ages 56-95 was 25?-34? The average forward elevation for the ages 15-55 was 85?-95?and the ages 76-95 was 55?-64? The most difficult movement for the olde subgroup of patients was internal rotation which was up to the sacrum. Conclusion: Our results show that good fracture stability and functional outcome can be obtained from the use of the PHILOS plate. Early mobilisation of the shoulder can be achieved without compromising fracture union. We would recommend the use of the PHILOS plate for the management of displaced fractures of the proximal humerus.

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